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Fast Approximate Quantification of Endovascular Stent Graft Displacement Forces in the Bovine Aortic Arch Variant.
Sturla, Francesco; Caimi, Alessandro; Romarowski, Rodrigo M; Nano, Giovanni; Glauber, Mattia; Redaelli, Alberto; Votta, Emiliano; Marrocco-Trischitta, Massimiliano M.
Afiliação
  • Sturla F; 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Caimi A; Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy.
  • Romarowski RM; Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy.
  • Nano G; 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Glauber M; Vascular Surgery Unit, Cardiovascular Department, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
  • Redaelli A; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy.
  • Votta E; Minimally Invasive Cardiac Surgery Unit, Istituto Clinico Sant'Ambrogio, Milano, Italy.
  • Marrocco-Trischitta MM; Department of Electronics Information and Bioengineering, Politecnico di Milano, Milano, Italy.
J Endovasc Ther ; 30(5): 756-768, 2023 10.
Article em En | MEDLINE | ID: mdl-35588222
PURPOSE: Displacement forces (DFs) identify hostile landing zones for stent graft deployment in thoracic endovascular aortic repair (TEVAR). However, their use in TEVAR planning is hampered by the need for time-expensive computational fluid dynamics (CFD). We propose a novel fast-approximate computation of DFs merely exploiting aortic arch anatomy, as derived from the computed tomography (CT) and a measure of central aortic pressure. MATERIALS AND METHODS: We tested the fast-approximate approach against CFD gold-standard in 34 subjects with the "bovine" aortic arch variant. For each dataset, a 3-dimensional (3D) model of the aortic arch lumen was reconstructed from computed tomography angiography and CFD then employed to compute DFs within the aortic proximal landing zones. To quantify fast-approximate DFs, the wall shear stress contribution to the DF was neglected and blood pressure space-distribution was averaged on the entire aortic wall to reliably approximate the patient-specific central blood pressure. Also, DF values were normalized on the corresponding proximal landing zone area to obtain the equivalent surface traction (EST). RESULTS: Fast-approximate approach consistently reflected (r2=0.99, p<0.0001) the DF pattern obtained by CFD, with a -1.1% and 0.7° bias in DFs magnitude and orientation, respectively. The normalized EST progressively increased (p<0.0001) from zone 0 to zone 3 regardless of the type of arch, with proximal landing zone 3 showing significantly greater forces than zone 2 (p<0.0001). Upon DF normalization to the corresponding aortic surface, fast-approximate EST was decoupled in blood pressure and a dimensionless shape vector (S) reflecting aortic arch morphology. S showed a zone-specific pattern of orientation and proved a valid biomechanical blueprint of DF impact on the thoracic aortic wall. CONCLUSION: Requiring only a few seconds and quantifying clinically relevant biomechanical parameters of proximal landing zones for arch TEVAR, our method suits the real preoperative decision-making process. It paves the way toward analyzing large population of patients and hence to define threshold values for a future patient-specific preoperative TEVAR planning.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Implante de Prótese Vascular / Procedimentos Endovasculares Tipo de estudo: Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Implante de Prótese Vascular / Procedimentos Endovasculares Tipo de estudo: Prognostic_studies Limite: Humans Idioma: En Ano de publicação: 2023 Tipo de documento: Article